Cancer and Oncology NCLEX Quiz 1
Which of the following clients is most at risk for developing multiple myeloma? a) A 60 yr old African American man b) A 52 yr old Hispanic woman c) A 35 yr old White man d) A 25 yr old Asian woman
a) A 60 yr old African American man - Correct Answer: A. A 60-year-old African-American man Option A: Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often in Black men.
Which of the following complications are the three main consequences of leukemia? a) Anemia, infection, and bleeding tendencies b) Bone deformities, spherocytosis, and infection c) Polycthemia, decreased clotting time, and infection d) Lymphocytopoiesis, growth delays, and hirsutism
a) Anemia, infection, and bleeding tendencies - Correct Answer: A. Anemia, infection, and bleeding tendencies Option A: The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Option B: Bone deformities don't occur with leukemia although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn't a feature in leukemia. Mature cells aren't produced in adequate numbers. Option C: Anemia, not polycythemia, occurs. Clotting times would be prolonged. Option D: Hirsutism and growth delay can be a result of large doses of steroids but isn't common in leukemia.
The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care? a) Encourage fluids b) Providing frequent oral care c) Coughing and deep breathing d) Monitoring red blood cell count
a) Encourage fluids - Correct Answer: A. Encouraging fluids Option A: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain an output of 1.5 to 2 L a day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options B, C, and D: These are components in the plan of care but are not the priority in this client.
What are the three most important prognostic factors in determining long-term survival for children with acute leukemia? a) Histological type of disease, initial WBC count, and client's age at diagnosis b) Progression of illness, WBC at the time of diagnosis, and client's age at the time of diagnosis c) Histologic type of disease, initial platelet count, and type of treatment d) Type of treatment and client's sex
a) Histologic type of disease, initial WBC count, and client's age at diagnosis - Correct Answer: A. Histologic type of disease, initial WBC count, and client's age at diagnosis Option A: The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a better prognosis because of age 2 or after 10.
During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease? a) Increased vascularity of the breast b) History of anovulatory cycles c) Cyclic changes in mass size d) History of early menarche
a) Increased vascularity of the breast - Correct Answer: A. Increased vascularity of the breast Option A: An increase in breast size or vascularity indicates the growth of a tumor and is consistent with cancer of the breast. Options B, C, and D: Early menarche, as well as late menopause or a history of anovulatory cycles, are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well-demarcated and freely moveable.
According to a standard staging classification of Hodgkin's disease, which of the following criteria reflects stage III? a) Involvement of lymph node regions or structures on both sides of the diaphragm b) Involvement of two or more lymph node regions or structures c) Involvement of single node region or structure d) Involvement of extralymphatic organs of tissues
a) Involvement of lymph node regions or structures on both sides of the diaphragm - Correct Answer: A. Involvement of lymph node regions or structures on both sides of the diaphragm Option A: Hodgkin lymphoma is classified into stages to determine the state of the disease and where it has already spread. Stage III involves nodes on both sides of the diaphragm. Option B: Stage II involves two or more lymph node regions. Option C: Stage I only involves one lymph node region. Option D: Stage IV involves extra lymphatic organs or tissues.
A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing: a) Metabolic alkalosis b) Respiratory acidosis c) Metabolic acidosis d) Respiratory alkalosis
a) Metabolic alkalosis - Correct Answer: A. Metabolic alkalosis The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29 mEq/L.
Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia? a) Oral poliovirus vaccine (OPV) b) Hepatitis B vaccine c) Diphtheria and tetanus and pertussis (DPT) vaccine d) Haemophilus influenzae type b vaccines (Hib)
a) Oral poliovirus vaccine (OPV) - Correct Answer: A. Oral poliovirus vaccine (OPV) Option A: OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be indicated because it isn't a live virus and wouldn't pose the threat of infection. Options B, C, and D: DTP, Hib, and hepatitis B vaccines can be given accordingly to the recommended schedule.
Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? a) Ovarian cancer b) Endometrial polyps c) Cervical dysplasia d) A dermoid cyst
a) Ovarian cancer - Correct Answer: A. Ovarian cancer Option A: Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important. Option B: Endometrial polyps are outgrowths in the endometrium that are mostly non cancerous and the exact cause is unknown. Option C: Cervical dysplasia is the abnormal cell growth in the lining of the cervix that is related with human papillomavirus (HPV) infection. Option D: Dermoid cysts are abnormal growth found in the ovary that usually contain material such as skin, hari, teeth, nails, fat, and sweat glands that were trapped during fetal development.
The client with which of the following types of lung cancer has the best prognosis? a) Squamous cell b) Oat cell c) Small cell d) Andenocarcinoma
a) Squamous cell - Correct Answer: A. Squamous cell Option A: Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Options B and C: Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize. Option D: Adenocarcinoma is the next best lung cancer to have in terms of prognosis.
When a client has a lobectomy, what fills the space where the lobe was? a) The remaining lobe or lobes over-expand to fill the space b) The lung space fills up with serous fluid c) The space stays empty d) The surgeon fills the space with gel
a) The remaining lobe or lobes over expand to fill the space - Correct Answer: A. The remaining lobe or lobes over expand to fill the space Option A: The remaining lobe or lobes over expand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. Option C: The space can't remain "empty" because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. Option B: Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift. Option D: The surgeon doesn't use a gel to fill the space.
The client with a benign lung tumor is treated in which of the following ways? a) The tumor is removed, involving the least possible amount of tissue b) The tumor is left alone unless symptoms are present c) The tumor is treated with radiation only d) The tumor is treated with chemotherapy only
a) The tumor is removed, involving the least possible amount of tissue - Correct Answer: A. The tumor is removed, involving the least possible amount of tissue Option A: The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead to respiratory decompensation. Options B, C, and D: If for some reason it can't be removed, then radiation or chemotherapy may be used to try to shrink the tumor.
Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia? a) To assess for central nervous system infiltration b) To aid in the classification of the leukemia c) To rule out meningitis d) To decrease intracranial pressure
a) To assess for central nervous system infiltration - Correct Answer: A. To assess for central nervous system infiltration Option A: A spinal tap is performed to check if leukemia has infiltrated into the central nervous system specifically to the cerebrospinal fluid (CSF). Options B and D: It wouldn't be done to decrease ICP nor does it aid in the classification of leukemia. Spinal taps can result in brain stem herniation in cases of ICP. Option C: A spinal tap can be done to rule out meningitis but this isn't the indication for the test on a leukemic client.
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? a) "Cancer cells are susceptible to drug toxins." b) "Chemotherapy affects all rapidly dividing cells." c) "Chemotherapy encourages cancer cells to divide." d) "The molecular structure of the DNA is altered."
b) "Chemotherapy affects all rapidly dividing cells." - Correct Answer: B. "Chemotherapy affects all rapidly dividing cells." Option B: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Option A: All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins. Options C and D: Chemotherapy slows cell division. Not all chemotherapeutic agents affect the molecular structure.
Which of the following types of leukemia carries the best prognosis? a) Basophilic leukemia b) Acute lymphoblastic leukemia c) Acute myelogenous leukemia d) Eosinophilic leukemia
b) Acute lymphoblastic leukemia - Correct Answer: B. Acute lymphoblastic leukemia Option B: Acute lymphoblastic leukemia, which accounts for more than 85% of all childhood cases, carries the best prognosis compared to adults. Survival rate depends on the person's age or white blood cell count at time of diagnosis and individuals with cell subtypes such as pre-B also considered to have a higher survival rate than those with mature B-cell leukemia. Options A and D: Basophilic and eosinophilic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis. Option C: Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children.
Angela, a clinical instructor is conducting a lecture about chemotherapy. Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? a) Faster growing cells are more susceptible to chemotherapy b) Faster growing cells are less susceptible to chemotherapy c) Slower growing cells are more susceptible to chemotherapy d) Non-dividing are a) Faster growing cells are more susceptible to chemotherapy b) Faster growing cells are less susceptible to chemotherapy c) Slower growing cells are more susceptible to chemotherapy d) Non-dividing cells are more susceptible to chemotherapy
b) Faster growing cells are less susceptible to chemotherapy - Correct Answer: B. Faster growing cells are less susceptible to chemotherapy Option B: The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Options A, C, and D: Slow-growing and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as they begin active cell division.
The nurse is teaching a 17-year old client and the client's family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? a) Dyspnea b) Fever c) Tachycardia d) Chills
b) Fever - Correct Answer: B. Fever Option B: A patient with neutropenia has a decreased number of neutrophils. These cells are responsible for fighting off bacteria once they enter the body. A complication of neutropenia is infection. An early sign is a fever that requires clinical intervention to identify potential causes. Options A and D: Chills and dyspnea may or may not be observed. Option C: Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.
When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. a) Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present b) If unable to aspirate blood, reposition the client and encourage the client to cough c) Contact the health care provider about verifying placement fifth status is questionable d) Inspect the insertion site for swelling, erythema, or drainage e) Verify patency of the line by the presence of a blood return at regular intervals
b) If unable to aspirate blood, reposition the client and encourage the client to cough c) Contact the health care provider about verifying placement fifth status is questionable d) Inspect the insertion site for swelling, erythema, or drainage e) Verify patency of the line by the presence of a blood return at regular intervals - Correct Answer: B, C, D, and E A major concern with the intravenous administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent evaluation of blood return when administering vesicant or non vesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is questionable and may require a declotting regimen.
Which of the following substances has abnormal values early in the course of multiple myeloma (MM)? a) Red blood cells b) Immunoglobulins c) White blood cells d) Platelets
b) Immunoglobulins - Correct Answer: B. Immunoglobulins Option B: MM is characterized by malignant plasma cells that produce an increased amount of immunoglobulin that isn't functional. Option A: As more malignant plasma cells are produced, there's less space in the bone marrow for RBC production. Options C and D: In the late stage of the disease, platelets and WBC's are reduced as the bone marrow is infiltrated by malignant plasma cells.
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? a) increased WBCs b) Increased calcium levels c) Decreased blood urea nitrogen d) Decreased number of plasma cells in the bone marrow
b) Increased calcium levels - Correct Answer: B. Increased calcium levels Option B: Hypercalcemia (increased calcium level) is caused by the release of calcium from the deteriorating bone tissue in multiple myeloma. This may cause symptoms of excessive thirst, constipation, dehydration, nausea, frequent urination, dizziness, confusion, and eventually to coma. Options A and C: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow and elevated uric acid levels. Option D: An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma
A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder? a) Altered red blood cell production b) Malignant proliferation of plasma cells and tumors within the bone c) Altered production of lymph d) Malignant exacerbation in the number of leukocytes
b) Malignant proliferation of plasma cells and tumors within the bone - Correct Answer: B. Malignant proliferation of plasma cells and tumors within the bone Option B: Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Option D: Malignant exacerbation in the number of leukocytes describes the leukemic process. Options A and C: Altered RBC and lymph production are not characteristics of multiple myeloma.
Maria was recently diagnosed with Hodgkin's lymphoma. Upon the early diagnosis, the nurse will expect which of the following areas is often involved? a) Chest b) Neck c) Groin d) Pelvis
b) Neck - Correct Answer: B. Neck Option B: A common early sign of Hodgkin lymphoma is swelling in one or more lymph nodes, which is often seen in the neck. Options A, C, and D: Lymph nodes can also be found in the chest, groin, and pelvis but aren't yet involved in the earliest stage of the disease.
A centrally located tumor would produce which of the following symptoms? a) Shoulder pain b) Pleuritic pain c) Coughing d) HEmoptysis
c) coughing - Correct Answer: C. Coughing Option C: Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow, producing such symptoms as coughing, wheezing, and stridor. Option A: Pancoast tumors that occur in the apices may cause shoulder pain. Option B: As the tumor invades the pleural space, it may cause pleuritic pain. Option D: Small cell tumors tend to be located in the lower airways and often cause hemoptysis.
The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states which of the following is characteristic of the disease? a) Prognosis depends on the stage of the disease b) Occurs most often in the older client c) Presence of Reed-Sternberg cells d) Involvement of lymph nodes, spleen, and liver
b) Occurs most often in the older client - Correct Answer: B. Occurs most often in the older client Option B: Hodgkin's disease is a disorder of young people up to age 40 and among adults. It is more common in adolescents between the ages of 15 and 19. Option A: Hodgkin's lymphoma prognosis depends on the stage of the disease. It is treatable in the early stages of the stages. Option C: Hodgkin's disease is marked by the presence of Reed-Sternberg cells which are the abnormal B lymphocytes (WBC that produces antibodies that are essential in combating infections). Option D: The disease spread through the lymph vessels from lymph node to lymph node. It can also travel to other parts such as the lung, liver, and spleen.
In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions? a) Prepare the client's will b) Provide pain control c) Provide nutritional support d) Provide emotional support
b) Provide pain control - Correct Answer: B. Provide pain control Option B: The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort therefore improving the quality of life of the patient. Examples of pain medication used with advanced cancer are opioids such as morphine, oxycodone, fentanyl, or methadone. Option A: Nursing care doesn't focus on helping the client prepare the will. Option D: Preparing the client and his family for the impending death and providing emotional support is also important but shouldn't be the primary focus until the pain is under control. Option C: Nutritional support may be provided, but as the terminal phase advances, the client's nutritional needs greatly decrease.
Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? a) Generalized weakness b) Recurrent pleural effusion c) Dizziness d) Hypotension
b) Recurrent pleural effusion - Correct Answer: B. Recurrent pleural effusion Option B: If cancer is suspected in the lungs, it can cause fluid accumulation in the pleura called pleural effusion. This fluid build-up takes up space and fills the pleural cavity resulting in the compression of the lungs making it hard for the client to breathe properly. Options A, C, and D: Dizziness, generalized weakness, and hypotension aren't typically considered warning signals, but may occur in advanced stages of cancer.
The nurse is reviewing the chart of a client who is newly diagnosed with chronic lymphocytic leukemia. Which of the following laboratory values is expected to be seen? a) Elevates aspartate aminotransferase and alanine aminotransferase levels b) Thrombocytopenia and increased lymphocytes c) Elevated sedimentation rate d) Uncontrolled proliferation of granulocytes
b) Thrombocytopenia and increased lymphocytes - Correct Answer: B. Thrombocytopenia and increased lymphocytes Option B: Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present. Option A: Chronic lymphocytic leukemia often does not cause abnormal liver function tests. Option C: An elevated ESR result is often seen with multiple myeloma and Waldenstrom's macroglobulinemia (a type of non-Hodgkin's lymphoma that is characterized by excessive production of white blood cells). Option D: Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia.
Which of the following treatment measures should be implemented for a child with leukemia who has been exposed to chickenpox? a) Acyclovir (Zovirax) should be started on exposure b) VZIG should be given within 72 hours of exposure c) No treatment is indicated d) Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of disease
b) VZIG should be given within 72 hours of exposure - Correct Answer: B. VZIG should be given within 72 hours of exposure Option B: Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the course of the disease. Option A: Acyclovir may be given if the child develops the disease but not if the child has been exposed. Option C: Chickenpox can cause severe complications in children afflicted with leukemia if left untreated. Option D: Giving the vaccine at the onset of symptoms wouldn't likely decrease the severity of the illness.
A diagnosis of Hodgkin's disease was made to a 58- year old man and is admitted for the initial cycle of chemotherapy. During the hospitalization, the nurse should watch out for the following complication, except? a) Fertility problems b) Benign prostatic hyperplasia c) Secondary cancer d) Infection
b) benign prostatic hyperplasia - Correct Answer: B. Benign prostatic hyperplasia Option B: Hodgkin's disease (Hodgkin's lymphoma) is a type of cancer that affects the lymphatic system (bone marrow, spleen, liver, and lymph node tissue. Symptoms include painless swelling of a lymph node, recurrent fever, night sweats, pruritus, and unexplained weight loss. Prostate involvement is rare in Hodgkin's disease. Options A, C, and D: Complications of the disease would lead to a weakened immune system resulting in various infections, It can also result in fertility problems related to chemotherapy, and a probability of secondary cancers in the future.
A 40-year-old male diagnosed with acute lymphocytic leukemia finished his first cycle of chemotherapy. Which of the following statements by the patient warrants further teaching by the nurse? a) "You can eat soft cheeses from pasteurized milk." b) "You can enjoy the turkey on the day of the thanksgiving party." c) "Try eating sashimi in one of the famous Japanese restaurants around the city." d) "A medium-well steak is a good idea of a sumptuous meal."
c) "Try eating sashimi in one of the famous Japanese restaurants around the city." - Correct Answer: C. "Try eating sashimi in one of the famous Japanese restaurants around the city" Option C: A low bacteria diet would be indicated with excludes of raw or undercooked fish such as sashimi due to the risk of exposure from harmful bacteria. Option A: Soft cheeses are allowed if they are made from pasteurized milk. Options B and D: Cooked meat such as medium well steak and turkey are rich in protein that can help the patient maintain strength and prevent weight and muscle loss.
In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client? a) Severe aplastic anemia b) Severe combined immunodeficiency c) Acute lymphocytic leukemia d) Chronic myeloid leukemia
c) Acute lymphocytic leukemia - Correct Answer: C. Acute lymphocytic leukemia Option C: For the first episode of acute lymphocytic leukemia, conventional therapy is superior to bone marrow transplantation. Treatment is usually long-term chemotherapy and is composed of 3 phases (induction, consolidation, and maintenance). Options A and B: In severe combined immunodeficiency and in severe aplastic anemia, bone marrow transplantation has been employed to replace abnormal stem cells with healthy cells from the donor's marrow. Option D: In myeloid leukemia, bone marrow transplantation is done after chemotherapy to infuse healthy marrow and to replace marrow stem cells ablated during chemotherapy.
A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? a) Wear loosely woven clothing for added ventilation b) Apply sunscreen only after going in the water c) Apply sunscreen with a sun protection factor (SPF) of 30 or more before sun exposure d_ Avoid peak exposure hour from 9am to 1pm
c) Apply sunscreen with a sun protection factor (SPF) of 30 or more before sun exposure - Correct Answer: C. Apply sunscreen with a sun protection factor (SPF) of 30 or more before sun exposure Option C: According to The American Academy of Dermatology A sunscreen with a SPF of 30 or higher should be worn on all sun-exposed skin surfaces is recommended as a protection against ultraviolet A (UVA) and ultraviolet B (UVB) rays. Option A: Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Sun Tanning parlors should be avoided. Option B: It should be applied 15 to 30 minutes before sun exposure and reapplied after being in the water. Option D: Peak sun exposure usually occurs between 10 am to 2 pm.
Nurse Donald is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery? a) Pain at the incisional site b) Complications of decreased sensation near the operative site c) Arm edema on the operative d) Sanguineous drainage in the Jackson-Pratt drain
c) Arm edema on the operative side - Correct Answer: C. Arm edema on the operative side Option C: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. The surgery damages some of the nodes and vessels that lymph moves through resulting in a backup of fluid into the body's tissue. Options A and B: Pain and decreased sensation in the chest area is normal and it is caused by the damaged nerves in the armpit and chest during the surgery. Option D: A sanguineous drainage in the Jackson-Pratt drain is normal postoperatively. This output from the drain decreases each day and the color will turn into light yellow or light pink.
A client with leukemia has neutropenia. Which of the following functions must be frequently assessed? a) Heart sounds b) Bowel sounds c) Breath sounds d) Blood Pressure
c) Breath sounds - Correct Answer: C. Breath sounds Option C: Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Options A, B, and D: Although assessing blood pressure, bowel sounds, and heart sounds is important, it won't help detect pneumonia.
A child is seen in the pediatrician's office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia? a) Increased activity level b) Increased appetite c) Petechiae d) Abdominal pain
c) Petechiae - Correct Answer: C. Petechiae Option C: The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Petechiae is brought about by damaged or broken blood vessels underneath the skin. Option A: Leukemia increases inflammation in the body, which can make a person feel tired and experience fatigue causing decreased activity level. Option B: Increased appetite can occur but it usually isn't a presenting symptom. Option D: Abdominal pain may be caused by areas of inflammation from normal flora within the GI tract or any number of other causes.
Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient? a) Teaching the client diaphragmatic breathing techniques b) Administering cough suppressants as ordered c) Teaching and encouraging pursed-lip breathing d) Placing the client in a low semi-Fowlers position
c) Teaching and encouraging pursed-lip breathing - Correct Answer: C. Teaching and encouraging pursed-lip breathing Option C: For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion. Option A: Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder. Option B: Administering cough suppressants will not help the respiratory effort. Option D: A low semi-Fowler's position does not encourage lung expansion. Lung expansion is enhanced in the upright position.
Which of the following is the primary goal for surgical resection of lung cancer? a) To remove all of the tumor and any collapsed alveoli in the same region b) To remove as much of the tumor as possible, with removing any alveoli c) To remove the tumor and as little surrounding tissue as possible d) To remove the tumor and all surrounding tissue
c) To remove the tumor and as little surrounding tissue as possible - Correct Answer: C. To remove the tumor and as little surrounding tissue as possible Option C: The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. There is a possibility of cancer cells remaining in the body after the operation so additional treatment modalities such as chemotherapy and radiation therapy are done. Options A, B, and D: It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.
Parents of pediatric clients who undergo irradiation involving the central nervous system should be warned about postirradiation somnolence. When does this neurologic syndrome usually occur? a) Immediately b) Within 1 to 2 weeks c) Within 5 to 8 weeks d) Within 3 to 6 months
c) Within 5 to 8 weeks - Correct Answer: C. Within 5 to 8 weeks Option C: Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3 to 15 days. It's characterized by somnolence with or without fever, anorexia, nausea, and vomiting. Although the syndrome isn't thought to be clinically significant, parents should be prepared to expect such symptoms and encourage the child to rest.
Which of the following assessment findings in a client with leukemia would indicate that cancer has invaded the brain? a) Hypervigilant and anxious behavior b) Increased heart rate and decreased blood pressure c) Headache and vomiting d) Hypervigilant and anxious behavior
c) headache and vomiting - Correct Answer: C. Headache and vomiting Option C: The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain. The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache, vomiting, irritability, lethargy, and eventually, coma. Option B: Increasing intracranial pressure in brain metastasis would result in symptoms of high blood pressure, decreased pulse rate, and abnormal respirations known as Cushing triad. Options A and D: Often children with a variety of illnesses are hypervigilant and anxious when hospitalized.
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? a) When therapy is completed b) Immediately after nausea begins c) with the administration of therapy d) 30 min. before the initiation of therapy
d) 30 min. before the initiation of therapy - Correct Answer: D. 30 minutes before the initiation of therapy Option D: Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. Options A, B, and C: If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.
A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? a) A segment of the lung, including a bronchiole and its alveoli b) One entire lung c) A lobe of the lung d) A small, localized area near the surface of the lung
d) A small, localized area near the surface of the lung - Correct Answer: D. A small, localized area near the surface of the lung Option D: A wedge resection is a surgical procedure that involves the removal of a small area of tissue close to the surface of the lung. It is indicated for clients with certain types of lung cancer such as non-small cell lung cancer (NSCLC). It is done in combination with chemotherapy and radiation therapy. Options A and C: A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy. Option B: An entire lung is removed in a pneumonectomy.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? a) Assess skin turgor b) Assess bowel sounds c) Assess temperature d) Assess level of consciousness
d) Assess level of consciousness - Correct Answer: D. Assess level of consciousness Option D: A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option A: Skin turgor will be assessed if there is a presence of dehydration in a patient with low platelet count but it is not the priority. Option B: Bowel sounds will be assessed when there is a presence of gastrointestinal complications such as constipation, diarrhea, and radiation enteritis. Option C: Assessing the temperature is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.
Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? a) High-dose chemotherapy b) Early bronchoscopy c) Smoking cessation d) Early detection
d) Early detection - Correct Answer: D. Early detection Option D: Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it's detectable on a chest x-ray, so this is difficult. Option A: High-dose chemotherapy has minimal effect on long-term survival. Option B: A bronchoscopy may help identify cell type but may not increase the survival rate. Option C: Smoking cessation won't reverse the process but may help prevent further decompensation.
Nurse Andrei is caring for a client with multiple myeloma. During the review of the laboratory results. The nurse will monitor the client for which of the following conditions? a) Hypermagnesemia b) Hyperkalemia c) Hypernatremia d) Hypercalcemia
d) Hypercalcemia - Correct Answer: D. Hypercalcemia Option D: Patients with multiple myeloma develop a bone disease that causes bone destruction. Calcium is released during this, causing an increase in serum calcium levels. Options A, B, and C: MM doesn't affect potassium, sodium, or magnesium levels.
If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes the extent of a surgery that can be performed? a) It doesn't affect it b) It may require a whole lung to be removed c) The entire tumor may not be able to be removed d) It may prevent surgery if the client can't tolerate lung tissue removal
d) It may prevent surgery if the client can't tolerate lung tissue removal - Correct Answer: D. It may prevent surgery if the client can't tolerate lung tissue removal Option D: If the client's preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with chemotherapy and radiation. Option A: A pre-existing pulmonary disease affects the ability of a client with lung cancer to tolerate surgical therapy. Option B: Removing the whole lung is recommended if the cancer is located in the central area of the lung or if it cannot be fully removed with lobectomy. Option C: A preexisting lung condition does not limit the option for the removal of the entire tumor because a tumor that is not entirely removed poses a threat of the spread of cancer cells to nearby tissues.
Joseph who had a history of long-term smoking and alcoholism is diagnosed with oropharyngeal cancer. He is admitted into the chemo unit for the initiation of chemotherapy. Which of the following tests is performed before the infusion of chemotherapeutic agents? a) Complete blood count (CBC) b) Peripheral blood smear c) Lumbar puncture d) Liver function test
d) Liver function test - Correct Answer: D. Liver function test Option D: Liver and kidney function studies are done before the initiation of chemotherapy to evaluate the client's ability to metabolize the chemotherapeutic agents. Option A: A CBC is performed to assess for anemia and white blood cell count. Option B: A peripheral blood smear is done to assess the maturity and morphology of red blood cells. Option C: A lumbar puncture is performed to assess for central nervous system infiltratio
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention is the highest priority in the nursing plan of care? a) Monitoring temperature b) Monitoring for pathological factors c) Ambulation three times a day d) Monitoring the platelet count
d) Monitoring the platelet count - Correct Answer: D. Monitoring the platelet count Option D: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A: Relates to monitoring for infection particularly if leukopenia is present. Options B and C: Although monitoring the pathological factors and ambulation are important in the plan of care. They are not related directly to thrombocytopenia.
Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia? a) Vincristine (Oncovin) b)Prednisone c) Oral nystatin suspension d) Sulfamethoxazole and trimethoprim (Bactrim)
d) Sulfamethoxazole and trimethoprim (Bactrim) - Correct Answer: D. Sulfamethoxazole and trimethoprim (Bactrim) Option D: The most frequent cause of death from leukemia is an overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed. Option A: Vincristine, an antineoplastic agent is used in the treatment for leukemia but is not used as a prophylaxis against pneumonia. Option B: Prednisone isn't an antibiotic and increases susceptibility to infection. Option C: Oral nystatin suspension would be indicated for the treatment of thrush.
The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: a) That testicular examination should be done at least every 6 months b) To gently feel the testicle with one finger to feel for a growth c) To examine the testicles while lying down d) The best tie for the examination is after a shower
d) The best tie for the examination is after a shower - Correct Answer: D. The best time for the examination is after a shower Option D: The testicular-self examination is recommended monthly after a warm shower or bath when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps. Option A: Testicular self-examination is done at least once a month. Option B: Testicles are examined using both hands by placing the index and middle fingers under the scrotum. Option C: To do the exam, the patient should stand in front of a mirror.
The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions? a) stress b) exposure to radiation c) viral factors d) low-fat and high-fiber diet
d) low-fat and high-fiber diet - Correct Answer: D. Low-fat and high-fiber diet Option D: A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer. Option A: Increased stress has been associated with causing the growth and proliferation of cancer cells. Option B: Two forms of radiation, ultraviolet and ionizing, can lead to cancer. Option C: Viruses may be one of the multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer.